Multifetal Gestation and Long-Term Maternal Health.

Low-dose aspirin in pregnancy: 81 mg vs 162 mg - Is there a role for personalized medicine?

Placental pathology after resolved antepartum sepsis: Evidence of persistent vascular and inflammatory injury.

Pre-eclampsia is a serious complication of pregnancy that contributes to maternal and neonatal morbidity and mortality. Maternal endothelial dysfunction, particularly in the kidney, liver and cerebral vascular beds, causes the key clinical features of hypertension and proteinuria as well as the potentially fatal complications of eclampsia: stroke, acute kidney injury and liver dysfunction. The placenta has a key role in moderating these systemic maternal responses and potentially also changes in fetal growth. As pre-eclampsia progresses, the dysfunctional placenta produces toxins that contribute to maternal endothelial dysfunction and disease development. These toxins, including the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFLT1), can be utilized as biomarkers. Other pathophysiological contributions to placental dysfunction, including ischaemia, inflammation and senescence, as well as risk factors such as older maternal age, obesity, diabetes mellitus, chronic hypertension or multifetal gestation, may help to explain differences in disease presentation. Chronic kidney disease is a risk factor for the development of pre-eclampsia during early pregnancy, and early pre-eclampsia may reflect undiagnosed underlying kidney disease in some patients. Furthermore, pre-eclampsia is a risk factor for kidney and cardiovascular disease in the mother and baby in later life. Understanding the pathways that contribute to pre-eclampsia facilitates the development of potential prevention strategies and treatments for early-presenting disease with severe features.

We aimed to investigate whether advanced maternal age is associated with cesarean delivery in nulliparous individuals undergoing elective induction of labor (eIOL). We queried a multicenter outpatient electronic medical record to perform a retrospective cohort study of nulliparous individuals undergoing eIOL between 390/7 and 406/7 weeks from January 2017 to June 2024. To investigate the relationship between age and eIOL, we created multiple study cohorts: (1) Age <35 years, (2) age 35-39 years, and (3) age ≥40 years. We excluded pregnancies complicated by multifetal gestation, oligohydramnios, hypertensive disorders, diabetes requiring treatment, autoimmune disorders, or fetal growth restriction. The primary outcome was the rate of cesarean delivery, and secondary outcomes included indication for cesarean delivery and adverse maternal and neonatal outcomes. Of the 84,156 eligible individuals, 932 met our inclusion criteria, with 728 (78.1%), 141 (15.1%), and 63 (6.8%) with age <35 years, 35-39 years, and ≥40 years, respectively. We found an increased incidence of cesarean delivery with increasing age (25.8% for age <35 years, 41.1% for age 35-39 years, and 55.6% for age ≥40 years, p < 0.01). After adjusting for confounders including pre-pregnancy body mass index (BMI), diet-controlled gestational diabetes, and in vitro fertilization, and using age <35 years as the reference in a multivariable regression, this relationship remained consistent (age 35-39: adjusted odds ratio (OR) = 1.82 [95% confidence interval (CI): 1.14-2.91], and age ≥40: adjusted OR = 3.70 [95% CI: 1.90-7.22]). Aside from cesarean for arrest of dilation, there were no significant differences noted in the indications for cesarean delivery or other adverse outcomes. Our findings highlight an association between increasing maternal age and cesarean delivery among nulliparous individuals undergoing eIOL. Further studies should determine whether biologic or immunologic factors play a role or whether altered labor management may improve these outcomes. · Among patients undergoing eIOL, increased age is associated with cesarean delivery.. · After adjusting for confounders in multivariable regression, age remained associated with cesarean delivery.. · Future studies are needed to determine the etiology of increased cesarean delivery with maternal age..

Triplet and higher-order multifetal pregnancies are associated with significant obstetric complexity and neonatal morbidity. The rise of multifetal gestations is mostly attributed to advances in assisted reproductive technology; however, more recent practice changes aim to reduce the incidence given the associated risks. Recommendations for enhanced antepartum care include additional screening for obstetric complications, tailored ultrasonography surveillance, and counseling regarding interventions for risk reduction, including multifetal pregnancy reduction. Chorionicity remains the primary determinant of risk of perinatal mortality, with additional surveillance required for monochorionic twin pairs because of the complexity of shared placentation. Neonatal outcomes are largely driven by complications associated with prematurity, including respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, feeding immaturity, and prolonged neonatal intensive care unit hospitalization. Infants from monochorionic pairs within higher-order gestations may require specialized evaluation for cardiovascular compromise, anemia, and other sequelae of shared placentation. Delivery planning requires coordination across obstetric, neonatal, and other indicated specialty teams, with anticipation of simultaneous resuscitation and stabilization of multiple preterm infants. This review summarizes current evidence and consensus recommendations from the American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and American Academy of Pediatrics to guide the comprehensive management of higher-order multifetal pregnancies and optimize neonatal outcomes.

Postpartum depression (PPD) is a common mental health concern, but its occurrence among mothers with multiple sclerosis (MS) is not well established. Understanding this risk is important for guiding perinatal care. To investigate the risk of treatment-requiring PPD among mothers with MS compared to mothers without MS. We conducted a nationwide cohort study including all live births in Denmark from 1997 to 2023, using Danish national health registers. Treatment-requiring PPD was defined as redeemed prescriptions for antidepressants within 12 months postpartum, identified in the Danish National Prescription Register. Logistic regression models estimated crude and adjusted odds ratios (aORs), adjusting for maternal age, parity, preterm birth, multifetal gestation, and antidepressant use within 6 months before conception. Analyses were clustered by mother. Within 12 months postpartum, 236 of 2850 deliveries in women with MS (8.3%) and 58,778 of 1,532,959 deliveries of women without MS (3.8%) redeemed antidepressant prescriptions. Mothers with MS had higher odds of antidepressant use with aOR 1.9 (95% confidence interval (CI): 1.6-2.3). Mothers with MS have an elevated risk of treatment-requiring PPD. Enhanced monitoring and tailored mental health support during the perinatal period may be warranted.

Adverse perinatal outcomes associated with macrosomia in nulliparous women: A multicenter cohort study.

Fetal mortality significantly impacts reproductive efficiency in sheep, with approximately 30% of fetuses failing to survive until lambing. In multifetal gestation, partial litter loss (PLL) occurs in 28% to 37% of cases. The biochemical composition of allantoic fluid (ALF), which plays a key role in metabolic regulation and fetal waste clearance, has been shown in other species to reflect fetal development and maturity. However, ALF metabolomics in sheep, especially in relation to PLL, remains unexplored. This study investigated late-gestation fetal mortality in multifetal sheep pregnancies by analyzing maternal metabolic status, placental gene expression, and ALF composition to identify potential metabolic compounds associated with PLL. The study was conducted on 25 ewes, of which 14 experienced PLL, and 11 had vital litters (VL). Plasma analysis revealed that VL ewes have higher β-hydroxybutyrate concentrations than PLL ewes, whereas plasma insulin and cortisol levels are higher in PLL ewes. Analysis of gene expression in the placental cotyledon demonstrated increased androgen receptor expression in PLL pregnancies and trends toward elevated solute carrier family 2 member 1, and reduced nuclear receptor subfamily 3 group C member 1 expression. Insulin-like growth factor 2 expression tended to be higher in VL placentas. Allantocentesis was performed on 25 ewes with multifetal pregnancies (11 VL and 14 PLL). ALF samples were collected from 74 fetuses at 140.4 ± 2.0 days in pregnancy, and 41 samples were selected for metabolomic profiling. Using genomic analysis, 25 ALF samples were confidently matched to individual lambs. Untargeted lipidomics of ALF from 14 lambs in PLL (7 born alive vs. 7 stillborn) revealed 24 differentially abundant lipid compounds. Stillborn lambs exhibited lower phosphatidylglycerol (PG) 15:0_20:1, but higher levels of sphingomyelin (SM), lysophosphatidylcholine (LPC), ether-linked phosphatidylethanolamines (PEs), lysophosphatidylethanolamines (LPEs), and monogalactosyldiacylglycerols (MGDGs). Collectively, PLL in multifetal ewe pregnancies is linked to maternal metabolic imbalance, elevated cortisol levels, dysregulated placental gene expression, and altered ALF lipid profiles in stillborn fetuses. Elevated SM and LPC, and lower PG, suggest immature lungs. These molecular and metabolic signatures may provide new insights into the mechanisms underlying PLL in late-gestation multifetal pregnancies.

Comparing HELLP in multifetal gestations to HELLP in singleton pregnancies

CKD carries an increased risk for developing hypertensive disorders of pregnancy in multifetal pregnancies. CKD in multifetal pregnancies is associated with a shorter duration of gestation and an increased risk of having a baby small for gestational age. Multifetal pregnancies are a risk factor for hypertensive disorders of pregnancy compared with singleton gestations in patients living with CKD. CKD is a risk factor for adverse pregnancy outcomes in singleton pregnancies. Little is known about multifetal pregnancies in women with CKD. Owing to higher maternal age and the wider use of medically assisted fertilization, multifetal pregnancies are increasing. We aimed to review pregnancy outcomes in the largest multicenter series of multifetal pregnancies in women affected by CKD. This retrospective study gathered data from three Italian units with long-standing experience in the follow-up of pregnancy in women with CKD (2000-2023). Propensity score-matched (age, parity, body mass index, year of delivery) multifetal low-risk pregnancies and singleton pregnancies served as controls; multifetal pregnancies were also matched for chorionicity, amnionicity, and mode of conception. Intrauterine death of at least one fetus, given the low number of events, was explored in the overall multifetal cohorts. In this propensity score matched-cohort study, 52 multifetal pregnancies in women with CKD were associated with a significantly lower gestational age compared with 104 low-risk non-CKD controls (median 34.0 versus 36.0 gestational weeks [GWs]) and with lower-term delivery rate (9.6% versus 28.8%). Neonatal intensive care unit admission was more frequent in multifetal pregnancies with CKD (50.9% versus 25.2%, P = 0.003). Cox regression and Kaplan-Meier analyses confirmed the independent effect of CKD on gestation duration. In women with CKD, multifetal pregnancies had a markedly shorter gestation than singletons (median 34 versus 39 GW, P < 0.00001), with significantly higher risk of preterm birth <34 GW (odds ratio [OR], 9.733), small for gestational age (OR, 5.155), and neonatal intensive care unit admission (OR, 8.033). The difference was sharper than in low-risk non-CKD pregnancies (35 and 39 GW, respectively). This study, the largest assessing the risks of adverse pregnancy outcomes in women with CKD carrying more than one fetus, suggests that multifetal gestation is a strong additional risk. These findings highlight the need for further investigation and demonstrate the importance of careful counseling, particularly in medically assisted reproduction.

Background/Objectives: Preterm birth remains a major cause of neonatal morbidity and mortality, particularly in multiple pregnancies and in cases of cervical shortening. While cervical cerclage is established in singleton pregnancies, its efficacy in multiple gestations remains uncertain. This study compares pregnancy and neonatal outcomes following second-trimester cerclage in singleton and multiple pregnancies with a short cervix. Methods: In this retrospective cohort study, 96 women underwent second-trimester cerclage at a tertiary perinatal center between 2020 and 2024. All had a cervical length ≤ 25 mm or prolapsed membranes without infection or premature rupture. Primary outcomes included term delivery rate, gestational age, mode of delivery, and neonatal outcomes; secondary outcomes comprised surgical complications and rehospitalization, defined as the need for renewed inpatient care due to threatened preterm labor or procedure-related complications. Results: In total, 79 singleton and 17 multiple pregnancies were analyzed. Term delivery occurred more often in singletons (54%) than multiples (18%, p = 0.006). Mean gestational age at birth was 258 ± 25 days in singletons versus 228 ± 28 days in multiples (p &lt; 0.001). Birth weight was significantly lower in multiples (1985 g vs. 2943 g; p &lt; 0.001), and neonatal infections were more frequent (53% vs. 26%; p = 0.008). Caesarean delivery was more common in multiples (82% vs. 33%; p &lt; 0.001). Apart from increased postoperative contractions in multiples (24% vs. 5%; p = 0.031), complication rates and rehospitalization (27% vs. 29%; p = 0.8) were similar. Conclusions: Second-trimester cerclage is less effective in preventing preterm birth in multiple pregnancies compared to singleton pregnancies; however, it appears to be associated with a stabilizing clinical course and may facilitate outpatient management in selected high-risk cases. These findings support individualized counseling and shared decision-making, particularly in multifetal gestations.

Purpose: This study aims to determine whether new-onset proteinuria is a clinically significant predictor of adverse maternal and fetal outcomes in pregnancies complicated by chronic hypertension. Methods: This retrospective cohort study was conducted at a single center that included five birthing hospitals in the Metropolitan Detroit area, conducted between 2015 and 2022. The primary outcome measure was the development of superimposed preeclampsia with severe features. Secondary maternal outcomes included the development of preeclampsia without severe features, preterm delivery, and gestational age at delivery. Secondary fetal outcomes included fetal growth restriction and admission to the neonatal intensive care unit. Covariates analyzed included age, race, obesity, and presence of pregestational or gestational diabetes. All patients were treated with antihypertensive agents, specifically nifedipine or labetalol. Exclusion criteria included absence of baseline proteinuria assessment, absence of hypertension, multifetal gestation, or missing covariate data. Only the first pregnancy was included for patients with multiple pregnancies within the cohort. Descriptive statistics were reported as mean ± standard deviation for continuous variables and as frequencies with percentages for categorical variables. The normality of continuous variables was assessed using the Shapiro-Wilk test. Group comparisons based on new-onset proteinuria were conducted using a two-sample t-test for continuous variables and a Chi-square test for categorical variables. If the assumptions were not met, the Wilcoxon rank-sum test or Fisher’s exact test was applied. Poisson regression with robust error variances was used to calculate risk ratios (RR) and 95% confidence intervals (CI) for binary outcomes, while linear regression was used for continuous outcomes. Both unadjusted and adjusted models were analyzed, accounting for potential confounders. Statistical significance was defined as p &lt; 0.05. Results: Among the 3815 patients with chronic hypertension included in the study, 890 exhibited a normal baseline urine protein-to-creatinine ratio. During pregnancy, 248 (27.9%) developed new-onset proteinuria, while 642 remained without proteinuria. The incidence of new-onset proteinuria was significantly higher among Black patients. Those who developed new-onset proteinuria were more likely to experience adverse maternal and neonatal outcomes, including a significantly higher likelihood of developing preeclampsia with severe features (11.3% vs. 4.0%, p&lt;0.001), preterm delivery (51.6% vs. 22.3%, p&lt;0.001), and neonatal ICU admission (49.5% vs. 17.1%, p&lt;0.001). However, no significant association was found between new-onset proteinuria and preeclampsia without severe features (3.2% vs. 2.0%, p=0.33) or fetal growth restriction (15.7% vs. 18.1%, p=0.41). In both unadjusted and adjusted models, new-onset proteinuria remained significantly associated with increased risks of preeclampsia with severe features (RR 2.80, 95% CI 1.68–4.68; p&lt;0.001), preterm delivery (RR 2.17, 95% CI 1.80–2.63; p&lt;0.001), and neonatal ICU admission (RR 1.99, 95% CI 1.59–2.49; p&lt;0.001). Additionally, new-onset proteinuria was associated with a reduction in gestational age at delivery by 1.78 weeks (mean difference -1.78 weeks, 95% CI -2.25 to -1.30; p&lt;0.001). Conclusion: New-onset proteinuria in pregnancies complicated by chronic hypertension is significantly associated with an increased risk of superimposed preeclampsia with severe features, preterm delivery, and neonatal ICU admission. However, it is not associated with an increased risk of preeclampsia without severe features or fetal growth restriction. Additionally, new-onset proteinuria was linked to a reduction in gestational age at delivery. These findings underscore the clinical significance of proteinuria as a marker for severe maternal and neonatal outcomes in chronic hypertension. Further research is needed to better understand its role in informing management and risk stratification in this population.

By using the propensity score matching (PSM) method, this study compared the pregnancy outcomes of two ovulation induction regimens, clomiphene citrate (CC) and letrozole (LE), in intrauterine insemination (IUI) cycles. It aimed to evaluate the impact of these regimens on the clinical pregnancy rate, live birth rate, safety, and cost-effectiveness. Patients who underwent IUI with CC or LE monotherapy for ovulation induction from May 2024 to August 2025 were included. Baseline data and ovulation induction-associated parameters were retrieved from the electronic medical record system, and confounders were balanced by PSM. The clinical pregnancy rate and live birth rate served as the primary outcome measures of this study, while the biochemical pregnancy rate, implantation rate, OHSS incidence, multifetal gestation rate, and treatment cost constituted the secondary measures. 216 patients (108 each in the CC and LE groups) were included. Higher clinical pregnancy and live birth rates were confirmed in the LE group compared to the CC group (P<0.05). In the LE group, the first-trimester pregnancy rate and the second-trimester pregnancy continuation rate were superior (P<0.05). Concerning the implantation rate, the singleton pregnancy rate was higher and the multifetal gestation rate was lower in the LE group (P<0.05). The LE group also performed better in terms of Estradiol (E2) levels on the day of human chorionic gonadotropin (HCG) administration, with an elevated percentage of type A endometrium (P<0.05). LE shows higher pregnancy efficiency, better endometrial receptivity, and lower risk of multifetal gestation in IUI cycles.

Congenital Müllerian anomalies pose unique risks for complications in pregnancy, particularly in the setting of multifetal gestation. Uterine didelphys with dicavitary twin gestation remains a rare entity with fewer than 10 cases reported in the medical literature. Currently, there are no established guidelines for the management or delivery of dicavitary twin gestations. We report a case of naturally conceived dicavitary twins in the setting of uterine didelphys with two functional cervices and a prior vaginal septum excised in childhood. Delivery occurred in the 35th week of gestation via cesarean section with two low vertical hysterotomy incisions. Late-preterm delivery was recommended for maternal indications, specifically superimposed preeclampsia with severe features. Cesarean delivery was recommended due to malpresentation, with both fetuses in a double-footling breech position. The patient and twins were discharged home in good condition on Postpartum Day 3 (Day of Life 4). This case contributes to the literature on the management of a rare obstetric condition with favorable outcomes for the mother and infants, including a nuanced surgical technique.

Uterine contractions during labor reduce placental perfusion, which limits fetal oxygenation. Intrapartum fetal hypoxia and acidemia occur when there is insufficient reperfusion time between contractions or when placental dysfunction restricts oxygen transfer. The risks of hypoxic-ischemic injury during labor include intrapartum stillbirth, neonatal death, and neonatal encephalopathy. Emergency cesarean or instrumental deliveries are often required when fetal acidemia is suspected, though these interventions carry increased maternal and neonatal risk. Despite widespread use of electronic fetal heart rate monitoring to detect fetal compromise, rates of cerebral palsy, perinatal mortality, and other neonatal well-being measures have not improved. This highlights the need for more effective strategies to prevent adverse perinatal outcomes related to hypoxic injury. Phosphodiesterase type 5 inhibitors may be used to improve uteroplacental perfusion and enhance vasoconstriction in uterine and spinal arteries. Sildenafil citrate, a PDE5 inhibitor, has been used for indications related to placental dysfunction, to treat maternal hypertension, or both. A previous phase II randomized clinical trial (RCT) found that oral sildenafil reduced operative birth for fetal distress by 51% compared with placebo, but was underpowered to assess perinatal outcomes. The aim of this study was to assess whether oral sildenafil citrate during labor improves perinatal outcomes related to intrapartum hypoxia.The iSEARCH trial was a placebo-controlled, double-blind RCT conducted at 14 Australian hospitals from September 2021 to June 2024. Included were adult women with singleton or dichorionic twin pregnancies attempting vaginal birth at term, either by spontaneous labor or induction of labor. Excluded were those with monochorionic twins, triplets, higher-order multifetal gestation, or severe hepatic or kidney impairment. Also excluded were those taking nitrate-containing medications or other PDE inhibitors. Study participants were randomized 1:1 to receive 50mg sildenafil citrate or a placebo every 8 hours for a maximum of 3 doses. The primary outcome was a composite of 10 intrapartum or neonatal events, including intrapartum stillbirth, 28-day neonatal death, Apgar score <4 at 5 minutes, acidosis at birth, hypoxic ischemic encephalopathy, neonatal seizure, neonatal respiratory support, admission to the neonatal unit, persistent pulmonary hypertension of the newborn, or meconium aspiration syndrome. Secondary outcomes included the 10 individual primary outcomes and emergency cesarean delivery or instrumental vaginal birth for fetal distress.A total of 3257 women were included in the analysis, with 1626 in the sildenafil citrate group and 1631 receiving placebos. The primary composite outcome occurred in 5.1% of women in the intervention group and 5.2% in the placebo group [relative risk (RR), 1.02; 95% CI, 0.75-1.37]. No cases of infant death occurred. The sildenafil group had no effect on the individual secondary outcomes. There was also no effect on emergency operative birth for fetal distress (RR, 1.12; 95% CI, 0.98-1.29). In conclusion, no differences were observed in the incidence of adverse perinatal outcomes or emergency operative birth between women who received sildenafil citrate or placebo during labor.

Backgroundpreeclampsia (PE) remains a leading cause of maternal and perinatal morbidity and mortality worldwide. While metabolic and inflammatory factors are increasingly recognized in its pathogenesis, the clinical utility of composite biomarkers remains underexplored. This study aimed to investigate the association between the C-reactive protein-triglyceride-glucose (CRP-TG-glucose) index (CTGI), a novel marker of metabolic-inflammation stress, and the risk of preeclampsia.MethodsThis retrospective cohort study included 11,916 pregnant women, of whom 486 developed preeclampsia. Maternal baseline characteristics were compared between the PE and non-PE groups. Logistic regression analyses were conducted to identify factors associated with PE. The relationship between CTGI and PE risk was further explored using quartile stratification, restricted cubic spline regression, and threshold effect analyses. Subgroup analyses were also performed to assess interaction effects across maternal and obstetric variables.ResultsWomen with PE had significantly higher maternal age, body mass index (BMI), in vitro fertilization (IVF) conception, multifetal pregnancies, and elevated CTGI levels compared to non-PE counterparts (all P < .001). Multivariate logistic regression identified CTGI as an independent risk factor for PE (adjusted OR, 1.78; 95% CI, 1.51–2.09; P < .001), alongside BMI, maternal age, IVF, and multifetal gestation. A dose–response relationship was observed across CTGI quartiles, with the highest quartile showing a markedly increased PE risk (adjusted OR, 2.06; 95% CI, 1.52–2.81). Restricted cubic spline models and threshold analysis revealed a nonlinear association with a significant inflection point at CTGI = 2.244. Above this threshold, the risk of PE rose sharply (OR, 3.93; 95% CI, 2.09–7.39; P < .001). Subgroup analyses demonstrated consistent associations across maternal age, BMI, parity, plurality, and IVF status, without significant interaction.ConclusionsElevated CTGI in early pregnancy is independently and nonlinearly associated with an increased risk of preeclampsia, particularly above a critical threshold of 2.244. These findings underscore the potential clinical value of CTGI as an early risk stratification biomarker for PE, enabling timely intervention in high-risk pregnancies. Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s12944-025-02829-7.

Objectives: To evaluate the diagnostic and descriptive role of first-trimester ultrasound (FTU) in early pregnancy at a tertiary healthcare center. Methods: A retrospective observational study was conducted in which 120 pregnant women who underwent FTU (≤12 weeks gestation) between March 2024 and February 2025. Archived imaging and hospital records were reviewed to analyze obstetric and ultrasound data. Outcomes assessed included gestational age confirmation, detection of fetal cardiac activity, yolk sac evaluation, and diagnosis of early pregnancy complications. Statistical analysis was performed using the Statistical Package for the Social Sciences v23.0. Results: Of the 120 cases, 77.5% were viable singleton intrauterine pregnancies. Multifetal gestation was identified in 5.8% with chorionicity assessment possible in all twin pregnancies. Ectopic pregnancies and anembryonic gestations were each diagnosed in 5% of cases. Embryonic cardiac activity was present in 83.3% and yolk sac abnormalities were noted in 11.6%. The nuchal translucency was measured in 16.6% of cases (Mean NT 1.34±0.29 mm). Additional findings included subchorionic hematomas (3.3%) and adnexal masses (4.2%). Crown-rump length-based gestational dating closely agreed with last menstrual period-based estimates. Conclusion: FTU plays an important role in early pregnancy care by ensuring early diagnosis of both normal as well as abnormal pregnancies. It improves obstetric decision-making through accurate dating, identification of viability, and early detection of complications.

Objectives: To evaluate the diagnostic and descriptive role of first-trimester ultrasound (FTU) in early pregnancy at a tertiary healthcare center. Methods: A retrospective observational study was conducted in which 120 pregnant women who underwent FTU (≤12 weeks gestation) between March 2024 and February 2025. Archived imaging and hospital records were reviewed to analyze obstetric and ultrasound data. Outcomes assessed included gestational age confirmation, detection of fetal cardiac activity, yolk sac evaluation, and diagnosis of early pregnancy complications. Statistical analysis was performed using the Statistical Package for the Social Sciences v23.0. Results: Of the 120 cases, 77.5% were viable singleton intrauterine pregnancies. Multifetal gestation was identified in 5.8% with chorionicity assessment possible in all twin pregnancies. Ectopic pregnancies and anembryonic gestations were each diagnosed in 5% of cases. Embryonic cardiac activity was present in 83.3% and yolk sac abnormalities were noted in 11.6%. The nuchal translucency was measured in 16.6% of cases (Mean NT 1.34±0.29 mm). Additional findings included subchorionic hematomas (3.3%) and adnexal masses (4.2%). Crown-rump length-based gestational dating closely agreed with last menstrual period-based estimates. Conclusion: FTU plays an important role in early pregnancy care by ensuring early diagnosis of both normal as well as abnormal pregnancies. It improves obstetric decision-making through accurate dating, identification of viability, and early detection of complications.

: Post-dated pregnancy, defined as gestation extending beyond 40 weeks, is associated with increased maternal and perinatal risks such as oligohydramnios, macrosomia, meconium aspiration, fetal distress, PPH (Post-Partum Haemorrhage), and elevated rates of operative delivery. This study compares fetomaternal outcomes between pregnancies before 40 weeks and those extending beyond 40 weeks in order to guide timely obstetric interventions. Methods: A prospective cohort study was conducted at the Regional Institute of Medical Sciences, Imphal, from May 2023 to October 2024. A total of 106 adult pregnant women were enrolled and divided into two groups: post-dated pregnancies (&gt;40 weeks) and term pregnancies (37–40 weeks), each comprising 53 participants. Women with medical disorders, prior cesarean section, congenital anomalies, malpresentation, and multifetal gestations were excluded. Data on maternal demographics, type of labor, induction method, mode of delivery, neonatal outcomes, and complications were recorded. Statistical analysis was performed using SPSS v26, with p &lt; 0.05 considered significant. Results: Post-dated pregnancies showed higher rates of induction (49% vs. 22.6%) and cesarean section (35.85% vs. 11.32%). Severe oligohydramnios (36.8%) and cephalopelvic disproportion (26.3%) were the leading indications for caesarean delivery in the &gt;40-week group. Meconium-stained liquor was significantly more common in post-dated pregnancies (65.38% vs. 15.09%, p &lt; 0.05). PPH occurred in 34% of post-dated women compared to 7.5% in controls (p = 0.00185). The mean birth weight was higher in the post-dated group (3.23 kg vs. 3.05 kg, p = 0.018). NICU admissions were significantly increased among post-dated neonates (14 vs. 4, p = 0.01), primarily due to meconium aspiration syndrome and birth asphyxia. Lower APGAR scores were more frequent in the post-dated group. Conclusion: Pregnancies extending beyond 40 weeks are associated with significantly higher maternal and neonatal morbidity, particularly due to increased operative delivery, PPH, meconium aspiration, and NICU admissions. Timely monitoring and induction around 40 weeks may help reduce adverse outcomes.